Clin Oral Invest (2012) 16:15–23
DOI 10.1007/s00784-011-0636-6
REVIEW
Possible hazardous effects of hydrofluoric acid
and recommendations for treatment approach: a review
Mutlu Özcan & Arezo Allahbeickaraghi & Mine Dündar
Received: 2 September 2010 / Accepted: 26 October 2011 / Published online: 9 November 2011
# Springer-Verlag 2011
Abstract Hydrofluoric acid (HF) is commonly used for
conditioning the glass ceramics either prior to cementation
or for intraoral repair in prosthetic and restorative dentistry.
The present study offers a review of chemical properties of HF
used, highlight the possible hazardous effects of this agent,
and to recommend the treatment approach for potential risks.
Available published information documented in PubMed,
Medline, and Picarta literature databases was reviewed.
Additional information was derived from scientific reports,
medical and chemical textbooks, handbooks, product infor-
mation, manufacturers’ instructions, Internet web sites of the
HF manufacturers. No report was found on the incidence of
the hazardous effects of HF in dentistry. Reports from other
fields presented incidences of acute and chronic symptoms in
exposure to HF. While acute symptoms include skin or nail
burns, chronic ones involve systemic toxicity, eye injuries,
inhalation and ingestion-related symptoms that can be even
fatal. HF can be harmful and particularly aggressive to soft
tissues, but symptoms may not be apparent immediately after
exposure. The hazardous effects are not based on the pH
M. Özcan (*)
University of Zürich, Dental Materials Unit,
Center for Dental and Oral Medicine, Clinic for Fixed
and Removable Prosthodontics and Dental Materials Science,
Plattenstrasse 11,
CH-8032 Zurich, Switzerland
e-mail: mutluozcan@hotmail.com
A. Allahbeickaraghi
Dental School, University of Groningen,
Antonius Deusinglaan 1,
9713 AV Groningen, The Netherlands
M. Dündar
Department of Prosthodontics, School of Dentistry,
Ege University,
35100 Izmir, Turkey
value, but on the toxicity of HF. Potential hazards of HF
known from other applications than dentistry should be
considered also in dental applications. Especially the clini-
cians, who often deal with adhesive cementation or repair of
glass ceramics, should take necessary precautions for possible
hazards of HF.
Keywords Dental ceramics . Dentistry . Hazardous
compounds . Hydrofluoric acid
Introduction
Highly concentrated, pure aqueous solution of hydrofluoric
acid (HF) was first prepared in 1809 and hydrogen fluoride was
first obtained at the end of the eighteenth century [1, 2]. From
chemistry perspective, HF is the inorganic acid of elemental
fluorine. Hydrogen fluoride is produced by the reaction of
calcium fluoride (CaF2) and sulfuric acid in a reaction furnace
at 200°C, which is then cooled and stored as a colorless liquid
[1, 2]. The main source of CaF2 to produce hydrogen fluoride
is the mineral fluorspar. The volatile HF is condensed and
purified by distillation [1, 2]. HF can be produced through
processes such as aluminum melting, ceramic production, and
phosphate fertilizers. It may also occur as an impurity in
different chemicals or can be produced through the reaction of
other chemicals [1]. It is the starting material for the
production of most organic and inorganic chemicals contain-
ing the fluorine atom. Fluorine gas is the most important
fluorine compound for industrial use.
HF solutions can be formed when fluoride salts are
acidified with acidic solutions. As it is a weak acid,
hydrogen fluoride in water for instance, is not completely
ionized. Its conjugate base, the fluoride ion F−, can re-
associate to form HF in solutions with low pH [3]. In strong
16
acidic solutions, the pH of the fluoride-containing mixture
will be low and the free F− formed from the ionization of
the fluoride salt in aqueous solution will exist as HF.
However, in acidic aqueous suspensions, solubility
increases by the presence of the acid, and with this route
a significant quantity of HF can be produced [1].
Early versions of HF were aqueous solutions. Aqueous HF
is commonly formulated for products with lower concentra-
tion. The major use of aqueous HF for occupational purposes
are etching and polishing glass and ceramics, removing sand
from metal castings, and cleaning processes for floors and
walls [3]. Other important uses include fabric rust removal,
etching silicon in semiconductors, cleaning stone and
marble, and manufacturing inorganic fluoride compounds
[4, 5].
Since the introduction of glass-based ceramics and discov-
ery of the benefits of adhesive cementation in dentistry, HF
started to be used to condition restorative and prosthetic
devices [6]. Strong bonds are formed between resin-based
materials and dental ceramics that are etched with HF [7].
This is based on the affinity of fluoride to silicon that is
higher than to oxygen: 4HF+SiO2→SiF4+2H2O. By the
selective removal of the glassy matrix, principally micro-
mechanical retention is achieved between the resin and the
etched ceramic. The greatest advantage of the use of HF for
ceramics is that its chair-side application is very simple, and
for this reason, sophisticated conditioning or cleaning
methods may not be necessary [8].
In 1998, in fields other than dentistry, HF was
acknowledged as a highly hazardous chemical due to its
toxicity, corrosiveness, and reactivity [1]. It can be used in
the anhydrous (100%) form or in aqueous solutions where
the latter range in concentration from <1–70%. Severity and
rapidity of onset of signs and symptoms depends on the
concentration, duration of exposure, and penetration to the
exposed tissue [6]. When accidentally released, HF can
diffuse as a dense vapor and aerosol. HF itself is not
flammable, explosive, or oxidizing, but it is a highly
reactive chemical. Hence, its storage conditions and
handling must be taken into account when using this acid.
Also, contact with metals can lead to the formation of
hydrogen gas, which forms explosive mixtures in air at
concentrations between 4% and 75% [1, 2]. The reaction
occurs at concentrations of approximately less than 65% of
aqueous HF but over time at higher concentrations of
anhydrous HF. In closed containers, hydrogen formation
can cause dangerously high pressures [9, 10]. As the
reaction of hydrogen fluoride or concentrated HF with
water is exothermic, it may react violently on mixing.
Concentrated aqueous solutions can fume in the air, and
heat is produced upon reaction.
The objective of this review was to summarize the
chemical properties, applications of HF used in medical or
Clin Oral Invest (2012) 16:15–23
other fields as well as in restorative and prosthetic dentistry, to
investigate the incidence of reports on hazardous effects of HF
in dentistry, to highlight the possible hazardous effects of this
agent in general, and to recommend the treatment approach
for potential risks, based on the published information
available in the chemical and medical fields.
Materials and methods
Original scientific papers listed in PubMed, Medline,
Picarta up to the end of 2010 on HF were included in this
review using the following search terms: hydrofluoric acid,
acid etching, surface conditioning, ceramics, fracture,
repair, hydrofluoric acid burns, hydrofluoric acid treatment,
hydrofluoric acid etching, workplace poisoning, poisoning,
fatalities, cementation, ceramics, intra-oral repair, fluorohy-
dric acid, fluoric acid, and hydrogen fluoride solution. Only
articles in English were selected. Additional information
was derived from scientific reports, medical and chemical
textbooks, handbooks, product information, manufacturers’
instructions, Internet web sites of the HF manufacturers.
Results
While no reports of incidence have been found on the
hazardous effects due to exposure to HF in the dental
literature, low incidence of reactions or even death presented
as case reports have been reported in the case of significant or
long exposure to HF in other fields. Potential hazards in case
of significant exposure and the therapy approach to each of the
symptom could be summarized as follows.
Acute hazardous effects
As with all inorganic acids, due to hydrogen ion degeneration
and corrosion, HF can burn the skin [11–13]. After penetrating
into the skin, it moves quickly to the deeper tissue layers and
releases the freely dissociable fluoride ion. Toxicity of this
ion is based on its strong reactivity. The mechanism of HF
injury is thought to be binding of fluoride ions to tissue
calcium and magnesium cations to form insoluble salt. These
interfere with cellular metabolism, inducing cellular death and
necrosis [4]. HF burns could be as a consequence of the
dehydrating effect of this agent and the low pH. Skin contact
with HF, even dilute solutions (0.1%) can cause painful
second- and third-degree burns that heal very slowly [10].
Burns have a rather characteristic appearance and present as
severely reddened, swollen areas with blanched, whitish
regions that rapidly progress to blistering, and necrosis
accompanied with pain [14]. Latent damages could also be
observed since fluoride ion penetrates through all layers of
Clin Oral Invest (2012) 16:15–23
the epidermis, dermis, and even the deeper subcutaneous
tissues, causing severe destruction, necrosis, and injuries to
the underlying bone due to decalcification [15]. The effect
can continue for several days, causing increased tissue
damage at a later stage. The damage is directly related to
the concentration of the acid and the duration of contact. HF
burns are classified according to the acid concentrations of 0–
20%, 21–50%, and greater than 50% [15–19]. Skin contact
with hydrogen fluoride, or solutions containing more than
50% HF, produces immediate pain. Reactions to more dilute
solutions (concentration 20–50%) may be delayed for
minutes to several hours. The accompanying pain is
excruciating and persistent, and healing is delayed [15–19].
Erythema and pain may be delayed up to 24 h in exposure to
dilute HF solutions (<20%).
Different types of therapy options have been suggested for
HF burns. The aim of all treatment methods is to chemically
sequester the fluoride ion and to prevent extensive, deep tissue
destruction [20]. The first treatment of chemical burns should
always be thorough and copious lavage of the wound to
clean the unreacted surface chemical and dilute that is
already in contact with the skin [20]. The second phase of
the treatment aims to inactivate the free fluoride ion by
promoting the formation of an insoluble fluoride salt. It was
reported that the calcium ion could decrease the toxic effects
of sodium fluoride in tissue [20, 21]. For this reason, calcium
gluconate gel (2.5%) is widely used for first aid and/or
primary treatment of skin burns due to exposure to HF [22–
30]. The gel is applied promptly and repeatedly onto the
burned area, up to several hours. Using this gel may be more
convenient for dilute acid burns that occur in exposure to
commercial products such rust removers, aluminum cleaners
using etching solutions [28]. If good relief of pain is not
obtained after 30–40 min, alternative methods of treatment
such as calcium gluconate injections or benzalkonium
chloride soaks should be considered. Calcium gluconate
injection (5%) is indicated for large burns (over 160 cm2) or
in cases where initial treatment has been delayed [31–34].
Burns of the fingers and nails permit penetration of fluoride
ions but prevent gels from being effective. Therefore, it may
be necessary to drill, split, or even remove nails to allow the
topical treatment methods to be effective. However, it was
reported that in less than 10% of the burns, removal of the nail
was necessary [31–34]. If burned nail is immersed in
benzalkonium chloride (Zephrian®) solution immediately, it
may be possible to avoid removing the nail.
Early aggressive surgery with primary excision of necrotic
skin areas has also been recommended as an emergency
measure to prevent deep tissue destruction and systemic
absorption of fluoride ions [35–41]. When painful indolent
ulcer remains resistant to all conservative measures, surgery
may be considered with the possibility of unacceptable
cosmetic results.
17
Chronic hazardous effects
HF is not classified as a carcinogen agent since no data exists
supporting this. However, increased rates of cancer have been
observed in workers exposed to a mixture of chemicals that
included fluoride, but no single chemical was identified and
reported as the cause of the cancer [13]. Yet, possible effects
on reproduction have been postulated [42]. Studies on
women exposed to fluoride for occupational reasons showed
increased rates of menstrual irregularities. Animal studies
also showed that fluoride impairs reproduction and increases
fetal bone and teeth malformation [43].
Systemic toxicity
In case of severe inhalation or ingestion of HF, systemic
toxicity is of concern.
To produce HF, CaF2 reacts with sulfuric acid:
CaF2 þ H2 SO4 ! 2HF þ CaSO4
2HF þ Caþþ ! CaF2
This process releases energy and occurs very quickly.
Although the pH value of HF is only 3.45, HF is soluble in
water by a strong reaction at every concentration. Since it is
very hygroscopic, it has the ability to dehydrate substances.
Hence, it can quickly penetrate into skin and other soft
tissues. When HF is exposed in concentrations of about 5%
to human skin, initially, in most cases, no pain or other
symptoms can be observed, but after several hours, a
painful burn reaction may become apparent [44–48]. There
is some evidence that when fluoride combines with calcium
and phosphate, intracellular levels increase [2, 44]. Binding
of fluoride to body calcium is one of the mechanisms of HF
toxicity [47–52]. One serious consequence of exposure to
HF is the decrease in serum calcium (hypocalcemia) and
other metabolic changes, which may result in a fatal
outcome if not recognized and treated [53–56]. Hypocalce-
mia should be considered as a potential risk in all instances
of inhalation or ingestion, especially when skin burns
exceed 160 cm2. Fluoride also binds to potassium and
magnesium ions leading to myocardial irritation and
arrhythmia. Chronic exposure to HF may cause skeletal
fluorosis that can be fatal [57–61]. Hemodialysis has been
reported to be an effective therapy for cases of severe
systemic intoxication [57–61].
Eye injuries
The eye is highly susceptible to HF liquid or vapor
exposures. Contact of HF with eyes may result in
permanent eye damage [58–60]. Ocular exposure may
denude the cornea and conjunctivae epithelium and lead
18
to stromal corneal edema, conjunctivae ischemia, slough-
ing, and chemosis [58, 59]. Deeper penetration of the
fluoride ion may cause corneal opacification and necrosis
of the anterior chamber structures. Usually, the effects are
noted within 3 days, although Hatai et al. described a case
of delayed corneal damage, it was not apparent until 4 days
after the exposure [59]. Latent complications included
recurrent corneal epithelial erosions, keratoconjunctivitis
sicca, progressive vascularization of the corneal stroma, and
symblepharon [58]. As for cutaneous burns, the most
important therapy is prompt and efficient lavage. This must
be immediate and continued for at least 15–30 min using
either water or normal saline [62–66].
Browne advised the use of a few drops of 10% calcium
gluconate after irrigation [62]. Trevino et al. recommended
1% gluconate in saline as an irrigant followed by 1% calcium
gluconate drops every 2–3 h for several days [63]. They have
reported complete recovery using this treatment in 18 out of
19 patients, of whom 13 had completely opacified corneas
prior to treatment [62]. Hatai et al. achieved quick, complete
recovery of a large corneal erosion caused by 49% HF using
a repeated instillation of 1% calcium gluconate drops
combined with conventional treatment [59]. Although others
also advised the use 1% calcium gluconate drops [41, 67], its
use remains empirical. McCulley et al. compared irrigation
with water, normal saline, magnesium chloride, lanthanum
chloride, 0.2% Hyamine, 0.03% and 0.05% Zephiran as well
as topical ointments of magnesium oxide and magnesium
sulfate [68]. These solutions were also tried as a 1-ml
subconjunctival injection. They showed that the only bene-
ficial treatments were irrigation with water, isotonic saline, or
isotonic magnesium chloride. Procedures involving repetitive
irrigation with these agents caused increased rates of corneal
ulceration. The same group has also studied the mechanism
of eye injury by HF, demonstrating a clear dose-related
response [68]. After irrigation, it is mandatory to request a
prompt ophthalmological opinion. Instillation of cycloplegics
to dilate the pupil may be required, and some advocate
steroid drops to lessen fibroblast formation in the cornea [63,
69]. Rubenfeld et al. are the only group who reported the use
of debridement of the sloughing necrotic conjunctiva in an
attempt to reduce the fluoride level further and aid in healing
[60]. However, speed of delivery of the irrigation remains the
most important step among all trials [58].
Inhalation
Inhalation of low concentrations of HF can cause severe
respiratory damage, irritation of the nose, sore throat, lungs,
pulmonary edema, burning sensation, cough, dizziness,
headache, nausea, shortness of breath, vomiting, and eye/
skin irritation [70, 71]. Animal studies have also showed
increased rates of kidney and liver damage as a result of HF
Clin Oral Invest (2012) 16:15–23
inhalation [42, 72–74]. Anhydrous HF is very volatile with
a boiling point of only 19.5°C, and even the aqueous
solutions (boiling points: 75% HF, 56°C; 60% HF, 89°C)
produce a pungent odor. The recommended level of HF in
the working atmosphere should not exceed 3 ppm which
could be noticed by smelling [75].
A particular hazard, as noted by Mayer and Guelich,
occurs when clothing is contaminated since this can
produce high concentrations in the inspired air [70]. They
reported the case of three workmen who died of pulmonary
complications following splashes to their cotton clothing
with 70% HF, all succumbing within 2 h of the incident.
Dieffenbacher and Thompson also reported about a
petroleum worker whose face and neck were in contact
with 10% HF for only 30–35 s [76]. Despite intravenous
and subcutaneous calcium gluconate application, he died
2 h later. Post-mortem findings showed thick mucus with
blood in the bronchi, edematous lungs with hemorrhagic
patches, and sub-serous hemorrhages in the pleurae. Green-
dyke and Hodge described similar post-mortem appearan-
ces in two men who died following a serious airway
exposure to HF of unspecified concentration [77]. High
blood fluoride levels were also present in these patients.
Chela and Huguet recorded the murder of a young woman
who had thrown HF to her face [78]. She died from acute
respiratory insufficiency 3 h after exposure.
Treatment of inhalational injuries begins with removing the
patient immediately from the contaminated area and admin-
istering humidified 100% oxygen as soon as possible. In an
attempt to neutralize the fluoride ion, some authorities
recommend a nebulized solution of 2.5–3.0% calcium
gluconate [41, 63]. If hemorrhage occurs, then bronchoscopy
would be necessary to avoid lobe collapse, and transfusion
may also be required [66]. Although corticosteroids have
been tried, they should be carefully indicated [63, 79, 80].
Ingestion
The first recorded fatality from fluoride poisoning was in
1873 when King reported the case of a 35-year-old man
who died within 35 min after drinking about 15 ml of HF
[81]. This demonstrates the speed of absorption of the
fluoride ion by the gastrointestinal tract. Since then, many
cases of fluoride poisoning have been recorded due to
ingestion [82–90]. Initial symptoms often include nausea,
vomiting, and abdominal pain. Ingestion of even relatively
dilute solutions of HF may be rapidly fatal.
Management of HF ingestion essentially remains as the
dilution, removal, and neutralization of the acid. Stimula-
tion to cause vomiting is not recommended since this may
cause further oral, esophageal, or pulmonary injury. The
patient should be encouraged to drink either water or
preferably milk that has been shown to be effective in
Clin Oral Invest (2012) 16:15–23
precipitating fluoride ions in vitro [90]. At the hospital,
gastric lavage can be considered and some advise the
addition of 10% calcium gluconate to the lavage fluid [91].
Extreme exposure and death
HF at concentrations of 30 parts per million (ppm) is
immediately dangerous to life [70, 71]. Fatalities have been
reported from a skin exposure to as little as 2.5% of body
surface area. Once it penetrates the skin, it slowly
disassociates into the hydrogen and fluoride ion. The
fluoride ion affects tissue integrity and metabolism by
liquefaction necrosis, decalcification, destruction of bone,
and production of insoluble salts. This will eventually result
in loss of calcium from the bones. The development of
hypocalcemia can be rapidly fatal because calcium is
important for muscles, including cardiac muscle. Without
calcium, many metabolic pathways are broken down.
Precautions to avoid HF exposure
Ventilation
Local exhaust ventilation is generally preferred because it
can control the emissions of the contaminant at its source,
preventing dispersion of it into the general working area
[92]. For emergencies or instances where the exposure
levels are not known, the use of a face-piece positive-
pressure, air-supplied respirator would be useful. It was
warned that air-purifying respirators do not protect workers
in oxygen-deficient atmospheres [92].
Skin protection
Protective clothing with long sleeves, air-inflated suits with
masks, goggles, including boots or safety shoes with
polyvinyl chloride or neoprene should be worn [92].
Eye protection
Chemical safety goggles and/or full-face shields should be
used where splashing is possible. Fountains and quick drench
facilities should be maintained in the work area [92].
Summary of major acute and chronic symptoms observed
after exposure to HF and the first aid measures are listed in
Table 1.
HF use in dentistry and clinical manifestations
HF types and quantities
Concentrations of HF used in dentistry are usually small,
ranging between 5% and 15%. They are available either in gel
19
or liquid form. It is indicated to be used both in vivo and ex
vivo. While the majority of the HF manufacturers for dental
use recommend its use with a rubber dam, others provide a gel
product, the so-called dental dam to protect adjacent gingival
and soft tissues from HF. In order to avoid the likelihood of
HF exposure and to make it more visible, coloring dyes are
added to make the product red, yellow, or green.
Metals
The application of HF (7.5% and 9.5%) for metals usually
takes place in the dental laboratories primarily for stripping
and cleaning metals. When a precious metal is cast with a
ceramic insert to produce a cylindrical hole that will receive
a pin, HF is used to dissolve the ceramic insert to the
casting [93].
Ceramics
The most common use of HF in dentistry is for conditioning
glassy-matrix ceramic surfaces to adhere resin-based materials
either prior to cementation or during repairs [94–97]. HF
selectively etches and dissolves the glass ceramic and cause
physical alteration of the surface creating micromechanical
retention. The ceramic is then rinsed with water spray. For
cementation purposes, HF etched restoration is placed in
neutralizing solution of CaCO3 and/or NaOCl. HF gel is
further removed in an ultrasonic bath. For intraoral repair
applications, ultrasonic cleaning of HF is not possible since
the restoration cannot be removed [97]. HF application is
then followed by silane coupling agent. Acid concentrations
and etching times vary depending on the specifications of the
ceramics to receive optimized adhesion of the resin-based
material.
Composites
Although some manufacturers claim that HF is effective for
conditioning resin-based composites also for cementation and
repair purposes, poor results were reported [98]. When
composites are exposed to HF acid gel, water monolayer
may penetrate via voids to fillers that, in turn, may disorganize
the siloxane network formed from the condensation of
intermolecular silanol groups, which is responsible for
stabilizing the filler-resin interface. For this reason, the use
of HF acid gel was not found to be a predictable option for
conditioning composite materials for repair or relamination
purposes.
Acidulated phosphate fluoride
The hazards, caustic effects to soft tissues and the danger
for clinical use for hydrofluoric acids are well-known by
20 Clin Oral Invest (2012) 16:15–23

Table 1 Major symptoms observed after exposure to hydrofluoric acid and the first aid measures

Hazards Possible symptoms First aida

Acute hazardous effects

Skin burns Redness, pain, blisters, swellings, necrosis
accompanied with pain
Nail injuries Necrotic skin around the nail, indulent ulcer
Chronic hazardous effects
Systemic toxicity Painful burn, hypocalcaemia, myocardial
problems, arrhythmia
Eye injuries Corneal eudema, conjuctivae ischemia, delayed
corneal damage, keratoconjuctivitis sicca,
vascularization of the corneal stroma
Inhalation Irritation of the nose, sore throat, lungs, burning
sensation, cough, dizziness, headache, nausea,
shortness of breath, vomiting, eye, skin,
pulmonary edema, possible kidney, liver
damage, hypocalcemia, death
Ingestion Nausea, vomiting, and abdominal pain
a
In all cases, a doctor should be consulted
Rinse skin with water, calcium gluconate
gel (2.5%) application or calcium luconate
injection, depending on the severity, remove
affected skin
Drilling, splitting, or removing nail, immersing
the nail in benzalkonium chloride
Immediate transfer to a medical center,
Haemodialysis
Efficient lavage (15–30 min) with water or
isotonic saline followed by application of
calcium gluconate drops, consulting an
ophthalmologist
Immediate transfer to a medical center, removing
the subject from the contaminated area,
nebulized solution of calcium gluconate
depending on the severity bronchoscopy,
transfusion
Drink water, milk, gastric lavage

the manufacturers and the researchers. For this reason,
some studies questioned whether 1.23% acidulated phos-
phate fluoride gels might serve as a safe and effective
substitute for etching ceramic surfaces to bond composite
resin to silanized ceramics [99–101]. It was concluded that
1.23% acidulated phosphate fluoride gels can substitute
9.5% HF but prolonged etching times were required with
the lower concentrations of HF [102]. However, the
specimens etched with 4% acidulated phosphate fluoride
gel, showed a wider statistical spread than the ones etched
with 9.6% HF. This suggested that HF etching might well
produce a more reliable and consistent result but this has
not been confirmed, as the sample size of these studies was
too small [100, 102].
Topical fluoride rinses and gels
Therapeutic fluoride products are also applied on teeth for
preventive purposes especially in pediatric dentistry. However,
HF is a minor ingredient in topical therapeutic fluoride.
Necessary precautions should still be considered using a
rubber dam during their application.
Concluding remarks
Since no incidence on hazardous effects of HF has been
reported in the dental literature, this literature review led to
the conclusion that risks of in vivo and ex vivo use of HF,
considering the concentrations used in dentistry appears to
be unwarranted. Since repair actions are rather seldom,
particularly the clinicians who indicate glass ceramic
restorations would be more likely to be exposed to HF
during cementation procedures. Concentrated solutions
cause immediate pain and produce a surface burn similar
to other common acids with erythematic responses,
blistering, and necrosis [52]. HF concentrations of
14.5% produce symptoms immediately and concentrations
of 12% may take up to an hour. Reaction to exposure of
7% HF or less, may take several hours before onset of
symptoms, resulting in delayed symptoms with the deeper
penetration of the HF. For occupational exposure, Amer-
ican Conference of Industrial Hygienists reported the
lowest limits by giving a maximum value (a limit that
should never be exceeded for even an “instantaneous”
exposure period of 3 ppm; 2.3 mg/m3) [103]. This
exposure limit (3 ppm) has also been given as 8 h time
weighed average level by the Occupational Safety and
Health Administration [103]. On the other hand, the
National Institute of Occupational Safety and Health
considered Dangerous To Life and Health value as
30 ppm [103]. Taking these values into account, for the
dental professionals and patients, a risk analysis could be
performed based on the frequency of the use of HF. Due to
the continuous use of HF in dentistry, the patients should
be monitored even after cementation or fixation of the
restorations. Knowing potential hazards of HF from other
Clin Oral Invest (2012) 16:15–23
fields, media other than HF gel have certainly potential in
the future for conditioning ceramic surfaces in dentistry.
Acknowledgments The authors thank to Assoc. Prof. Dr. H.G. Orhan,
Ege University, School of Pharmacy, Department of Toxicology, Izmir,
Turkey, for the helpful discussion and comments regarding to toxicity.
Conflict of interest The authors declare that they have no conflict of
interest.
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